The Changemakers of Health Care Delivery ANNUAL IMPACT REPORT 2019

Mission VillageReach transforms health care to reach everyone.

Photo Credit: Henry Sempangi Sanyulye A Message from the President to You Almost twenty years ago, VillageReach was founded to make sure that vaccines reached every rural health center in northern . From that original demonstration work, a movement was born. In 2019, in collaboration with partners across the globe, our solutions have improved access to health care for 43 million people across 10 countries in sub-Saharan .

Transforming health care delivery and systems for the most under-reached requires tremendous collaboration, collective action and partnerships. As I look back at 2019, one thing is clear - behind every success and every solution, there are changemakers. Changemakers champion transformative change in health care delivery in their communities. They work tirelessly every day to advocate for a world where each person has the health care needed to thrive. Today, we highlight some of the incredible milestones of 2019, and the changemakers who influenced them.

• : The handover of Chipatala cha pa Foni – or Health Center by Phone – to the Ministry of Health and Population represents a major milestone for the commitment to Universal Health Coverage in Malawi. In this report, you will meet Patience Tchwonge, a changemaker whose contributions helped make this possible.

• Mozambique: In Zambézia province, health centers would often run low on medicines and supplies. By partnering with the private sector, we made tremendous progress in supporting the government’s vision of a reliable, integrated supply chain that reaches every health center in 2019. In this report, you will meet Chaido Francisco Nomeado, a changemaker who is responsible for getting medical supplies regularly and safely to remote health centers.

• The Democratic Republic of Congo (DRC): It was a historic moment for a rural health center in Equateur province when the community gathered in August 2019 to watch the first children receive vaccines delivered by drones. In hard-to-reach communities, drones can provide a reliable and cost-efficient way to ensure health workers have access to life-saving vaccines and essential medicines for their patients. In this report, we will introduce you to Emmanuel Bosala, the changemaker who was there for the first delivery and vaccinated the first ten families.

In 2019, world leaders ratified a bold agenda for Universal Health Coverage. To reach these goals, we need to accelerate the pace of change. Gaps and inequities in health services are still leaving people behind, and targeted, cost-effective solutions are required to close these gaps.

We know that this change – both big and small – will require changemakers. Changemakers like Patience, Emmanuel and Chaido motivate us every day and remind us that people make health systems strong. Together, we will meet the challenges ahead.

Warm regards,

Emily Bancroft, President

A road in Equateur, Democratic Republic of Congo. Credit: Henry Sempangi Sanyulye 2 VillageReach Impact by the Numbers

In 2019 43 million people benefited from increased access to quality health care

2,000 health centers across sub-Saharan Africa have improved availability of medicines

12,000 health workers have access to data systems that provide the information they need to make critical decisions

1,300 health workers have greater capacity to manage health commodities, expand the scope of their services and deliver quality care

A sports utility vehicle traverses through grasses at the last mile. Credit: Denis Onyodi 3 Malawi

A Health Center is Only One Call Away for Expecting Mothers Patience Tchongwe always knew she would be ready to answer the call when it came to public Patience Tchongwe looks at hotline service. When she joined Malawi’s Chipatala cha pa Foni (CCPF), or health center by phone in information with a staff member. Credit: Joseph Brown Chichewa, her desire to make a difference was realized.

In 2015, Patience became a part of the hotline as a nurse midwife specializing in nutrition and food science. At that time, CCPF was only operating in two In 2019, the Chipatala cha pa districts with three volunteers behind the phones offering advice about Foni program expanded its maternal and child health. But even in its early stages, the Ministry of Health and Population (MoHP) and Patience’s team could see the value the hotline was reach ensuring nearly 7 million bringing to Malawians. Malawians had access to quality health information. “We were changing the lives of many people, and the Minister of Health saw that. He decided to hire more nurses with appropriate diplomas and qualifications,” Patience said.

From then on, Patience would spend long hours and late nights developing the critical health information and the necessary tools for her hotline workers, so that they could properly inform callers and bring them the health care they deserved. Her hard work paid off. She became a key liaison between the MoHP and VillageReach as CCPF transformed into a nationwide offering with an average of 3,000 calls per month.

“CCPF went from maternal health advice to covering questions about all health topics,” Patience said. Now standard health areas—including nutrition, water, sanitation and hygiene, infectious diseases, and sexual and reproduction health for young people—can be discussed with Malawians.

But through the program’s expansion and success, Patience never forgot CCPF’s initial roots as a resource for mothers and their children’s health. As the senior hotline supervisor, she worked diligently to talk with expectant mothers and leave messages for them on what to expect during their pregnancy and how to practice proper prenatal care. She wanted, more than anything, for women to understand the value and life-saving capabilities of having their child in a health facility.

4 In 2018, Patience began offering advice to Ellena from Chibwana, who was expecting and had reached out to CCPF for their expertise. Like many women in her village, Ellena had her first two children at home, but with her third child on the way, she wanted to heed the advice of a community health worker and take advantage of the hotline.

“We predicted her due date for her, so she would know when would be the best time to go to the health center for the baby’s delivery, which was important for her since the center was 14 kilometers away from where she lived,” Patience relayed. Thanks to the hotline, Ellena became the first woman to give birth in the Kwitanda Health Center rather than at home - a milestone for mothers in Ellena’s remote community.

The CCPF team had also projected Ellena’s due date perfectly, with her daughter Eliza born just one day before the hotline’s estimation. Patience saw the health care progress she had dreamed of come to life. Women were gaining health care knowledge and utilizing its transformative power for themselves and their children. The impact of her work had reached new heights, and there was no going back, only forward.

Several weeks after the birth of Eliza, Patience journeyed to Ellena’s village to visit the newborn child

In 2018, Patience (far right) and her team offered Ellena (second from right) advice on what and ask Ellena if she would encourage others in her to expect during her third pregnancy and also predicted her due date, so she would know community to use CCPF. “She volunteered to be an when to make the 14-kilometer journey to the local health center. Credit: VillageReach advocate for CCPF,” Patience stated with enthusiasm. “We also kept sending her messages and she continued to go to the center for her baby’s wellness visits. Other mothers will be calling CCPF and coming to the center now to deliver their babies because of her story.”

Incredible CCPF experiences like these are becoming the norm, and because of this, Patience was recognized for her dedication and meticulous work. In 2020, the State President of Malawi presented Patience and VillageReach Country Director Dr. Alinafe Kasiya with a prominent award recognizing CCPF as a Transformative Initiative for Malawi. The government of Malawi has complete confidence in CCPF’s power to bring health care information to its communities. Malawi’s MoHP completely took over operations for the health hotline. Twenty new hotline staff members received their first paycheck, which is demonstrative of the government’s commitment to CCPF. As she reflectsba ck on the last five years, Patience said, “There’s nothing better than seeing CCPF give Malawians the ability to make informed decisions about their health and greater autonomy over their future.”

“We’ve empowered Malawians like Ellena to take control of their health and imparted them with the knowledge they need, bringing about a great change in our public health care. Hospitals are even telling us how informed the CCPF people are and how they are asking for services.” Changemakers like Patience Tchongwe are transforming health care for everyone.

5 Mozambique

A Change of Wheels to Get Medicines to Health Centers In Mozambique, getting medicines to provincial warehouses is only one step in the supply chain journey. From there, changemakers like Chaido Francisco Nomeado ensure those medicines get to remote health centers. Chaido is a dispatch clerk responsible for delivering medicines to six health centers in the hardest-to- reach district in Zambézia province, Chinde. His journey requires several days, a “change of wheels” for a six-hour sailboat ride across the Zambezi River and a lot of discomfort navigating rough A mother rests in front of a health center on the first roads and battling mosquitoes. But to him, being a dispatch clerk is day of a vaccine campaign. Credit: Denis Onyodi not just a job, it is a mission.

“In the beginning you almost want to give up after your first distribution, but when you go there the second time and you feel the love health workers and In 2019, the Last Mile Supply Chain people have for you, you don’t think on the difficulties anymore,” Chaido said. program made 1,577 deliveries of “You are only thinking how to save those people and that inspires you.” essential medicines and supplies to health centers in Mozambique, VillageReach collaborated with Bolloré Transport and impacting the health and wellbeing Logistics to outsource medical supply delivery directly to of over 5 million people. health facilities as part of the government’s commitment to improve transportation and logistics.

Although Chaido’s trips can be long and challenging, the gratitude he receives from Chinde health workers and the community keep him coming back, ensuring everyone everywhere has access to life-saving medicines.

The Last Mile Supply Chain program is managed in partnership with the Government of Mozambique and Bolloré Transport and Logistics, with funding from the United States Agency for International Development (USAID). 6 Democratic Republic of Congo

Emanuel (pictured left) unpacks vaccines once the drone has landed in Widjifake. Credit: Henry Sempangi Sanyulye Drone Delivery of Vaccines is a In August 2019, 50 demonstration drone flights brought over 25 Gamechanger kilograms of health products to Approximately 6,500 people live in the surrounding areas of the Bikoro Territory five health centers in the province in Equateur province, Democratic Republic of Congo (DRC), where the Widjifake of Equateur, DRC. health center is located. Emmanuel Bosala is the head nurse at Widjifake, and he is a changemaker because so many people in the district rely on him to stay healthy.

Among his many health care duties, Emmanuel is responsible for the routine vaccination of 260 infants. Many families have been bringing their children for routine visits to him over the years. These families often travel long distances on foot seeking health care. When Emmanuel has to make his monthly 16-hour journey for vaccine supplies on challenging roads and waterways, he is not available to help his patients who must return another day for treatment. VillageReach, in partnership with the DRC Ministry of Health, the national civil aviation authority and Swoop Aero, set out to test the capability of vaccine delivery via drone.

Twenty minutes after the first demonstration flight took off, Emmanuel’s health center had its first vaccine delivery via drone. And after five days of demonstration flights, his health center had a three-month vaccine supply. Drone delivery in rural regions like Bikoro Territory can benefit everyone in the health district. When Emmanuel is able to stay at his health center, he can focus on what matters most—providing life- saving vaccines and health services to all.

7 Revenue and Expenses Interest and for FY2019 Individual Dividends Donations < 1% (10/1/2018 – 9/30/2019) 1.8% Other Income < 1% A scale at the health center where weight is a measure of health. Zambezia Province, Mozambique Credit: Denis Onyodi REVENUE Grants and Contracts $14,506,674 Individual Donations $267,215 Interest and Dividends $6,021 Grants and Contracts 98% Other Income $9,316 Total $14,789,226

Management Fundraising and General 1.5% 17.5% EXPENSES Program $12,630,028

Management and General $2,737,661 * VillageReach received a large multiyear grant in 2016; Fundraisingexpenditures relating to the grant occurred in$228,624 FY18.

Total $15,596,313 Program 81%

* VillageReach received a large multiyear grant in 2016; expenditures relating to the grant occurred in FY19.

8 VillageReach 2018 Board of Directors

Margaret Griffiths, Chair Mari Anderson Valerie Nkamgang Bemo Alexandra Brookshire Margaret Griffiths, Chair John Dew, Vice Chair Mari Anderson Valerie Nkamgang Bemo Rick Fant Michael Free Kari Glover Laura Herman Sena Kwawu Will Poole

Mothers and infants wait during a vaccination session; keeping to an immunization Paul Suzman schedule helps babies stay happy and healthy. Niassa, Mozambique Iyabo Tinubu-Karch Credit: Denis Onyodi Allen Wilcox

VillageReach Leadership Circle We are honored by the generosity of these Leadership Circle donors who contributed $500 or more between October 1, 2018 and September 30, 2019. Thank you for your commitment to VillageReach!

CHAMPIONS ADVOCATES Mary Ewing Patricia Devereux Mari Anderson and Terry Green Emily Bancroft and Andy Michael Free and Judith Van Arnam Neville Dowell Zan Brookshire and Bert Green Johnson* Nancy Geiger and Michael Krasik* Kai Draper* Joan Egrie Bill Dolan and Katharine Hunt* Freddie Goldberg and Carolyn Charlotte Gross Paul and Yaffa Maritz Christine Larsen and Glen Cooper Lakewold Marilyn and Thomas Halper Will Poole and Janet Levinger Johanna Miller* Steven Hakusa Laura and Tom Herman Mark and Monica Simpson Randy Rasmussen and Heather Jacqueline Howard Nancy Kessler Maia Suhr and Tim Carver Ross* Brian and Sharon Kidd Stefan Krasowski and Tess Zhao Allen Wilcox and Connie Melissa Ries and Pat Kennedy Kyle Krug Benjamin Maslow* Collingsworth Caleb Schwepker Ellen Lackermann and Neal Beverly and Thomas Miller Tim and Melissa Stumbles Stephenson Rajesh Nair INNOVATORS Anonymous David Mentz and Pam Smith Mentz Andrew Platzer Rick and Myrna Fant Jason Oubre and Arezoo Orouji Christine and Douglas Rohde Kari Glover and Thad Alston FRIENDS Paul and Linda Suzman Steven Wagner Margaret Griffiths* Paulo Abecasis* Suresh and Kalyani Velagapudi Melissa and Lowry West* Albert and Diane Kaneb Lucia Ballard* Sena and Jennifer Kwawu Jessica Batridge CONTRIBUTORS Murray Family Fund Valerie Nkamgang Bemo and Mitchell Abramson McIntyre Family Fund Tano Malentin Maria Celia Ramos Bellenzani* Monika and Bill Owens Mark and Judith Bloomberg Brandon and Kevin Bowersox- Rao and Satya Remala Foundation Johnson* Lee Rhodes and Peter Seligmann Jennifer Crouch* Kelly Camerer 9 FY2019 VillageReach Donors Thank you to these amazing donors who made gift to support VillageReach last year.

Michelle Adler Kristen Fagan Peter Kuliesis Laura Shackelford Tim Aerts* Martens Bash Foundation David Kuttruff Shantiban Shanmugam Camilla Albert Davide Gerbaudo Roy Larsen Roy Siddhartha Katherine Atkins Julia Masters Gest and Scott Gest Trevor Lillywhite Yudhbir Singh Ron and Sally Bancroft Emil Guliyev Malcolm Lockridge Rita Smith* M. Barusch and Greg Price* Rahul Gupta-Iwasaki Nohl Martin and Stephen Vella Michael Smith Enrica Basilico and Michael George Hahm Jason McCann Gerardo Snyder Megalli David Hale Lucy McKnight Carolyn Spolidoro Juliette Beck Anne Handschy James McNaul Dennis and Cindy Stalsberg Emily Bennighof* Jillian Hostenske Miriam Melnick* Jill Stein Arnab Biswas Caroline Christy and James Hans Melotte Bradley Stevenson Elias Block* Cunningham James Mendelsohn Charles Stewart Elizabeth Brennan Brock Paul Jaffe Sierra Mulkin Debbie Stone Janice Brockley Colin James* Farhan Murshed David Sugiman Teresa Campbell Kiera Javillonar Pamela and Glenn Nagami Thomas Junran Cao C.J. Jennings Le Nhi Randy Thomson* Rachel Chuang Corlan Johnson Guy Patching Jim and Kat Tillman Samuel Chun Thea Jones Lindsay Pedersen Albert Tseng Ian Craig* Ruth Kagi Olivia Price* Deepthi Uppala Jessica Crawford* Ramie Kamarakeh* Stanislaw Pruzhanski Ngozika Uzoma Kay and Mike Crouch Dean Kardassakis Karin Reed* Gerald and Veronika Walton Jacob Daffy Cathrael Kazin Debra Revere and Paul Schwartz Sean Ward Anthony De la Cruz* Vendel Kemeny Jennifer Rudy Chris Wells Mike DiMicco Kathryn and Michael Kevany John Sander and Theresa Lewis- Chris Xiao Jeff Dossett Mike Kinney Sander Etan Zapinsky George Dowdie Jonathan Kopechek Carl Schlichting* Jim Ericson Atin Kothari Erin Sekulich and Leen Kashyap

*Member of the ChangeMakers Club, providing monthly support for VillageReach

Organizational Supporters & Collaborative Partners

ORGANIZATIONAL Guidehouse Sall Family Foundation MATCHING FUNDERS JBJ Foundation Schwab Charitable Fund CORPORATIONS Agence Nationale de Vaccination Johnson and Johnson The Seattle Foundation Apple et des Soins de Sante Primaire Foundation Silicon Valley Community Bill and Melinda Gates Bill and Melinda Gates Management Sciences for Health Foundation Foundation Foundation MSD for Mothers Skoll Foundation Capella University Chemonics Mulago Foundation UBS Optimus Foundation Costco Community Church of Seattle Office Timeline The University of Texas at Austin Google David Weekley Family Foundation Open Road Alliance UNICEF Microsoft Corporation Gavi, the Vaccine Alliance PagerDuty USAID Starbucks Coffee Company GIZ Pfizer Foundation Vitol Foundation TIAA The Global Fund to Fight AIDS, The Robert McEldowney Jr. Family Tuberculosis and Malaria Foundation

VillageReach also wants to acknowledge our collaborative partners, from Ministries of Health in the Democratic Republic of Congo, Malawi and Mozambique, to trusted allies and friends. Our work is possible because we work together to transform health systems.

[email protected] villagereach.org 10